IMPACT OF MENTAL HEALTH–RELATED UNPLANNED LOSSES ONBOARD SURFACE SHIPS

The Surface Navy is experiencing increased unplanned losses (UPL) each year. In this interpretive study, we received and analyzed data from Naval Surface Forces Pacific Command (CNSP), looking for trends and patterns. Our data covered fiscal years 2019, 2020, 2021, and up to February 2022. The data showed that over the last two years, mental health has overtaken misconduct and drug abuse for the leading cause of UPLs across the Fleet. Upon this discovery, we questioned why mental health UPLs were rising and how we can reduce them. Currently, the term “unplanned loss” is undefined in any instruction. A previous study defined a UPL as “a loss to a command where a Sailor is issued a DD214." However, we believe it should be defined as “any loss of a Sailor from a command that is expected to last greater than 3 weeks.” By defining the term this way, it will allow commands to implement a standard operating procedure and corrective courses of actions to find a replacement Sailor and to account for temporary losses. We believe filling UPLs as quickly as possible will significantly slow down the domino effect of multiple UPLs onboard surface ships. Our research uncovered more question than answers, but we believe our recommendations and future research will greatly benefit the Fleet in the future.Lieutenant, United States NavyLieutenant, United States NavyApproved for public release. Distribution is unlimited

The Antiquarian and the Myth ofAntiquity: The Origins of Rome in Renaissance Thought, by Philip Jacks, Cambridge University Press, Cambridge

Attempts to understand the history of archaeology must inevitably face the issue of origins; while historical consciousness is common to human society, studying the past through the detailed excavation, analysis, and acquisition of its material remains has until recent generations been largely the domain of European society and its descendants. There is nothing inherently logical about this pursuit; the evolution of archaeology as a way of knowing the past has specifIc historical roots and antecedents in western society and needs to be understood in light of these circumstances. The Renaissance is arguably the cultural hearth in which archaeology took shape. Scholars of the age who seem to anticipate our own predilections. such as Cyriaco D'Ancona, are usually to be found in introductory chapters of archaeological textbooks immediately following Nabonidus of Babylon. Jacks takes a more contextual approach, discussing the relationships between scholarship and society in Italy from the late Medieval period through the 16th century. This is not a general history of antiquar­ian thought during the Renaissance, nor is it a study of the work of a specific individual. The author takes as his focus the changing perceptions of antiquity held by scholars of the age, with particular emphasis on the construction and manipulation of images of ancient Rome

Ancient Marbles to American Shores: Classical Archaeology in the United States. by Stephen Dyson, University of Pennsylvania Press, Philadelphia, 1998.

One of the aspects of 20th century archaeology in America that would undoubtedly perplex our 19th century predecessors is the extreme intellectual distance between Americanist, anthropological archaeologists and our counterparts who work in the classical world. We belong to different profes­sional societies, publish in different journals. occupy different academic departments, and draw our inspiration from different intellectual sources. Crossovers exist, but are comparatively rare, and are viewed with suspicion by all. One of my professors once announced to a seminar that if classical archaeologists didn't start doing something interesting, we would "have to take over.

Investigations of Aluminum-Doped Self-Healing Zircaloy Surfaces in Context of Accident-Tolerant Fuel Cladding Research

We present here some important results investigating aluminum as an effective surface dopant for increased oxidation resistance of zircaloy nuclear fuel cladding. At first, the transport behavior of aluminum into reactor grade zircaloy was studied using simple diffusion couples at temperatures greater than 770 K. The experiments revealed the formation of tens of microns thick graded Zr-Al layers. The activation energy of aluminum in zircaloy was found to be ~175 kJ/mol (~1.8 eV), indicating the high mobility of aluminum in zircaloy. Subsequently, aluminum sputter-coated zircaloy coupons were heat-treated to achieve surface doping and form compositionally graded layers. These coupons were then tested in steam environments at 1073 and 1273 K. The microstructure of the as-fabricated and steam-corroded specimens was compared to those of pure zircaloy control specimens. Analysis of data revealed that aluminum effectively competed with zircaloy for oxygen up until 1073 K blocking oxygen penetration, with no traces of large scale spalling, indicating mechanically stable interfaces and surfaces. At the highest steam test temperatures, aluminum was observed to segregate from the Zr-Al alloy under layers and migrate to the surface forming discrete clusters. Although this is perceived as an extremely desirable phenomenon, in the current experiments, oxygen was observed to penetrate into the zirconium-rich under layers, which could be attributed to formation of surface defects such as cracks in the surface alumina layers.Oak Ridge National LaboratoryU.S. Nuclear Regulatory Commissio

Posterior Vitreous Detachment and the Posterior Hyaloid Membrane

PURPOSE: Despite posterior vitreous detachment being a common ocular event affecting most individuals in an aging population, there is little consensus regarding its precise anatomic definition. We investigated the morphologic appearance and molecular composition of the posterior hyaloid membrane to determine whether the structure clinically observed enveloping the posterior vitreous surface after posterior vitreous detachment is a true basement membrane and to postulate its origin. Understanding the relationship between the vitreous (in both its attached and detached state) and the internal limiting membrane of the retina is essential to understanding the cause of rhegmatogenous retinal detachment and vitreoretinal interface disorders, as well as potential future prophylactic and treatment strategies. DESIGN: Clinicohistologic correlation study. PARTICIPANTS: Thirty-six human donor globes. METHODS: Vitreous bodies identified to have posterior vitreous detachment were examined with phase-contrast microscopy and confocal microscopy after immunohistochemically staining for collagen IV basement membrane markers, in addition to extracellular proteins that characterize the vitreoretinal junction (fibronectin, laminin) and vitreous gel (opticin) markers. The posterior retina similarly was stained to evaluate the internal limiting membrane. Findings were correlated to the clinical appearance of the posterior hyaloid membrane observed during slit-lamp biomicroscopy after posterior vitreous detachment and compared with previously published studies. MAIN OUTCOME MEASURES: Morphologic appearance and molecular composition of the posterior hyaloid membrane. RESULTS: Phase-contrast microscopy consistently identified a creased and distinct glassy membranous sheet enveloping the posterior vitreous surface, correlating closely with the posterior hyaloid membrane observed during slit-lamp biomicroscopy in patients with posterior vitreous detachment. Immunofluorescent confocal micrographs demonstrated the enveloping membranous structure identified on phase-contrast microscopy to show positive stain results for type IV collagen. Immunofluorescence of the residual intact internal limiting membrane on the retinal surface also showed positive stain results for type IV collagen. CONCLUSIONS: The results of this study provide immunohistochemical evidence that the posterior hyaloid membrane is a true basement membrane enveloping the posterior hyaloid surface. Because this membranous structure is observed only after posterior vitreous detachment, the results of this study indicate that it forms part of the internal limiting membrane when the vitreous is in its attached state

The use of high frequency oscillations to guide neocortical resections in children with medically-intractable epilepsy: How do we ethically apply surgical innovations to patient care?

AbstractPurposeResective surgical strategies are increasingly applied to treat medically-intractable epilepsy in children as uncontrolled seizures are associated with poor cognitive, developmental and behavioral outcomes. Innovative surgical strategies are, however, needed to improve outcomes and minimize the morbidity of such procedures.MethodThe current article utilizes an axiological approach to explore and highlight ethical issues in the use of high frequency oscillations (HFOs) to guide surgical resections in children with medically-intractable epilepsy. We frame our discussion in the context of the broader challenges in the application of surgical innovation to patient care.ResultsDespite a paucity of knowledge regarding their pathogenesis, limited evidence suggests the use of HFOs as biomarkers of epileptogenicity in resective procedures can improve seizure outcome. Clinicians must therefore weigh deficiencies in knowledge against the limited evidence supporting the utility of HFOs and make ethical decisions for the treatment of individual patients. Important ethical considerations for clinicians include the extent of deviation from established practice, the extent of evidence required to establish clinical validity, and the impact of technique implementation on equitable distribution of healthcare.ConclusionThe use of HFO signatures to guide neocortical resections represents a novel approach for the treatment of epilepsy. It is hoped that the issues discussed herein will contribute to and advance meaningful dialog on the ethical application of this surgical innovation to the treatment of a very vulnerable patient population

Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis.

ObjectiveTo perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery.Data sourcesElectronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.Study selectionWe included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion.Data extractionOne author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.Data synthesisTo identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.ResultsOf 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002) were associated with a good postoperative seizure outcome.ConclusionsSmall retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review

An assessment of candidate genes to assist prognosis in gastric cancer

Gastric cancer (GC) is the fourth commonest cancer worldwide, with the second highest mortality rate. Its poor mortality is linked to delayed presentation. There is a drive towards non-invasive biomarker screening and monitoring of many different types of cancer, although with limited success so far. We aimed to determine if any genes from a 32-gene panel could be used to determine GC prognosis. We carried out a retrospective study on the expression of 32 genes, selected for their proven or potential links to GC, on historic formalin fixed paraffin-embedded (FFPE) GC specimens from our unit. Gene expression was measured using quantitative nuclease protection assays (qNPA) technology. Following statistical analysis of the results, immunohistochemical staining for eight genes, both discriminating and non-discriminating, was conducted in seven age and sex matched non-metastatic: metastatic GC pairings. The stained samples were reviewed by two blinded consultant histopathologists. Multivariate Cox analysis of the gene expression data revealed metastatic status, age, sex and five genes appeared to influence GC survival. Genes negatively influencing survival included and (relative risks 2.20, 3.73 and 7.53 respectively). Genes conveying survival benefit included and (relative risks 0.10 and 0.24 respectively). Immunohistochemical staining of seven age and sex matched non-metastatic: metastatic pairs revealed no association between gene expression and protein expression. Our study found several genes whose expression may affect GC prognosis. However, immunohistochemical analysis revealed no association between gene expression and protein expression. It remains to be determined whether gene expression or protein expression are reliable means of assessing GC prognosis

α-Klotho expressison in human tissue

Context: α-Klotho has emerged as a powerful regulator of the aging process. To-date, the expression profile of α-Klotho in human tissues is unknown and its existence in some human tissue types is subject to much controversy. Objective: This is the first study to characterize system-wide tissue expression of transmembrane α-Klotho in humans. We have employed next generation targeted proteomic analysis using Parallel Reaction Monitoring (PRM) in parallel with conventional antibody-based methods to determine the expression and spatial distribution of human α-Klotho expression in health. Results: The distribution of α-Klotho in human tissues from various organ systems, including arterial, epithelial, endocrine, reproductive and neuronal tissues was first identified by immunohistochemistry. Kidney tissues showed strong α-Klotho expression, while liver did not reveal a detectable signal. These results were next confirmed by western blotting of both whole tissues and primary cells. To validate our antibody-based results, α-Klotho expressing tissues were subjected to PRM mass spectrometry identifying peptides specific for the full length, transmembrane α-Klotho isoform. Conclusions: The data presented confirms α-Klotho expression in the kidney tubule and in artery, and provides evidence of α-Klotho expression across organ systems and cell-types that have not previously been described in humans.K.L. received a Genzyme-Sanofi Fellowship in Nephrology grant. T.F.H. is funded by the NIHR award to the Cambridge Biomedical Research Centre and by NIHR grant 14/49/147. The Cambridge Aorta Study is funded by the British Heart Foundation.This is the author accepted manuscript. The final version is available from the Endocrine Society via http://dx.doi.org/10.1210/jc.2015-1800